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Humana Community HMO Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Community HMO Diabetes and Heart (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Community HMO Diabetes and Heart (HMO C-SNP) in 2026, please refer to our full plan details page.
Humana Community HMO Diabetes and Heart (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Jefferson County. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Community HMO Diabetes and Heart (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Community HMO Diabetes and Heart (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Community HMO Diabetes and Heart (HMO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Community HMO Diabetes and Heart (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $350.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan features an annual drug deductible of $350. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or preferred mail-order services. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a one-month supply at standard pharmacies and preferred mail order, with no copay for a three-month supply through preferred mail order. For Tier 3 preferred brand drugs, copays are $47 for a one-month supply, though you can save on a three-month supply through preferred mail order with a $94 copay. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 47% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance. This clear cost-sharing structure helps you manage your Medicare prescription drug costs effectively.
Additional Benefits
The Humana Community HMO Diabetes and Heart (HMO C-SNP) offers comprehensive coverage with no copay and no coinsurance for primary care visits, routine preventive services, and home health care. For specialized care, members pay a $35 copay for specialist visits, while emergency room visits carry a $130 copay that is waived if admitted. Inpatient hospital stays require a $350 daily copay for the first several days with no coinsurance, after which there is no copay. This plan also features robust supplemental benefits, including routine dental and vision care with no copay and no coinsurance up to specified annual limits. Routine hearing exams and over-the-counter hearing aids are also available with no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Additionally, members can access up to 36 free one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $350 daily copay for days 1 to 7 (no copay for days 8 and beyond) and psychiatric stays require a $350 daily copay for days 1 to 6 (no copay for days 7 to 90), but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $350, observation services carry a $350 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers primary care physician visits, occupational therapy, and physical or speech therapy with no copay and no coinsurance. Specialist visits, psychiatric care, and mental health services require a $35 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Humana Community HMO Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance for annual physicals, kidney disease education, and diabetes self-management. Additional preventive services are partially covered, offering a memory fitness benefit with no copay and no coinsurance, while health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers hearing services with no deductible and no coinsurance, offering Medicare-covered exams for a $35 copay, alongside routine exams, fitting evaluations, and OTC hearing aids with no copay. Prescription hearing aids are partially covered with copays ranging from $0 to $299 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP), featuring no copay and no coinsurance for a routine eye exam and covered eyewear, with a $550 annual limit. One pair of contact lenses or eyeglasses is covered per year, but other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) offers partially covered dental services with a $1,500 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive care, though Medicare-covered dental requires a $35 copay with no coinsurance and prosthodontics require a 30% coinsurance with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, are covered with no coinsurance to 20% coinsurance, with insulin drugs requiring a $35 copay.
Dialysis Services See details
The Humana Community HMO Diabetes and Heart (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers diagnostic and radiological services, with prior authorization required. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $105, while lab services, outpatient X-rays, and diagnostic radiological services feature no copay. Therapeutic radiological services require a minimum $40 copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. In practice, some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not necessary, additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers acupuncture with a $35 copay and no coinsurance for up to 20 treatments per year, alongside over-the-counter items and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and other miscellaneous services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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